Care Management Processes Important for High-Quality Diabetes Care.

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes Care Pub Date : 2023-10-01 DOI:10.2337/dc22-2372
Kevin A Peterson, Caroline S Carlin, Leif I Solberg, James Normington, Eric F Lock
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Abstract

Objective: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

Research design and methods: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used the Bayesian method to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to P < 0.01).

Results: Implementation of 18 of 62 CMPs was associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1% more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 47% of the total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a nonclinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit.

Conclusions: Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes.

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护理管理流程对高质量糖尿病护理至关重要。
目的:确定3年来初级保健实践中护理管理流程(CMP)的变化对糖尿病绩效指标和基于人群的临床结果的改善。研究设计和方法:这项重复的横断面研究跟踪了2017年和2019年330名初级保健机构队列中所有糖尿病患者的临床表现指标。分析单位为实践水平CMP暴露的患者年。因果推断是基于个体CMPs在不同年份之间的动态变化。我们使用贝叶斯方法同时估计了五个结果模型:A1c、收缩压和舒张压、基于指南的他汀类药物使用和最佳糖尿病护理(ODC)。我们控制未观察到的时间不变的实践特征和长期变化。我们对结果之间的误差相关性进行了建模。使用99%的贝叶斯可信区间确定统计学显著性(类似于P<0.01)。结果:62个CMPs中的18个CMPs的实施与患者结果的统计学显著改善相关。总之,这些结果使符合ODC绩效指标的患者增加了12.1%。不同的CMPs影响不同的结果。三种CMPs占ODC总改善的47%,A1c减少的68%,SBP减少的21%,他汀类药物使用增加的55%:1)识别和提醒应检测患者的系统,2)非临床医生的访视后随访,3)基于指南的临床医生在临床访视期间提醒预防服务。结论:有效提高初级保健质量的重点是重新设计实践,以明显改善糖尿病的结果。在初级保健中量身定制CMP的采用,通过重点改变糖尿病结果,有效改善ODC的表现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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